1. Chapter 16 First Aid

2. Providing First Aid Section 1

3. Objectives  Define first aid

4. Question  Read section 1, pages 449-452 (5 minutes)  What is first aid?  What type of people require first aid?

5. 16:1 Providing First Aid  Immediate care given to the victim of an accident or illness to minimize the effect of injury or illness until experts can take over  Reasons for providing correct first aid

6. Basic Principles of Providing First Aid  Remain calm and avoid panic  Evaluate situation thoroughly  Have a reason for anything you do  Treatment you provide will vary depending on type of injury or illness, environment, others present, equipment or supplies on hand, and availability of medical help

7. First Steps  Recognize that an emergency exists  Use all senses to detect problems  Sometimes signs of emergency are obvious and at other times they are less obvious

8. Next Steps  Check the scene and make sure it is safe to approach  What to observe  If not safe, call for medical help  If safe, approach the victim  Call emergency medical services (EMS) as soon as possible (continues)

9. Next Steps ( continued )  If possible, obtain the victim’s permission before providing any care  Triage if necessary  Check for other injuries  Obtain as much information as possible before you proceed

10. General Principles  Obtain qualified help  Avoid any unnecessary movement of the victim  Reassure the victim  Use a confident, calm attitude to help relieve victim’s anxiety  Avoid giving the victim anything to eat or drink (continues)

11. General Principles ( continued )  Protect the victim from cold or chilling, but avoid overheating  Work quickly in an organized and efficient manner  Do not make a diagnosis or discuss condition with observers at scene (continues)

12. General Principles ( continued )  Maintain confidentiality and protect the victim’s right to privacy while providing treatment  Make every attempt to avoid further injury or harm  Provide only the treatment you are qualified to provide

13. Cardiopulmonary Resuscitation Section 2

14. Objectives  Describe the basic principles of cardiopulmonary resuscitation for one-person rescue, two-person rescue, infants, children, and obstructed airway victims.

15. 16:2 Performing CPR  Cardiopulmonary resuscitation (CPR):  Cardio: _________  Pulmonary: ________  Resuscitation: to remove from apparent ________________  When performing CPR, you breathe for the patient and circulate ___________ (continues)

16. Performing CPR ( continued )  Purpose:  keep oxygenated blood flowing to the brain and other vital body organs  Performed until the ____ and ____ start working again or until medical help is available  Clinical versus biological death (continues)

17. ABCDs of CPR  A stands for ____________  B stands for ____________  C stands for ____________  D stands for ____________ (continues)

18. Airway  Open airway head-tilt/chin lift method 1. Put one hand on _________ 2. Put fingertips of other hand under bony part of ____ near the _____ 3. Tilt head back without closing the ________  Prevents ______from falling back and _____ air passage  If victim has suspected neck or upper spinal cord injury, try to open airway by lifting the _____ without tilting the _____ back.  If difficult to keep the jaw lifted with one hand, use ___________

19. Breathing  Breath into the victims ______ or ______  Supplies needed _________  Important to pinch the victim’s _____shut and make a tight seal around the victim’s _____ with your mouth to avoid loss of ______  Each breath should take about one second and the _____ should rise  ______ or forceful breaths should be avoided  Can force air into the ____ and _____ causing gastric distension  Can cause serious complications such as vomiting, aspirating fluids into the lungs and even cause ______

20. Circulation  Apply pressure to certain area of ______  Heart is compressed between _____ and ______  Blood is squeezed out of heart and into _______  _____ is supplied to the body cells

21. Defibrillation  Common cause of cardiac arrest is ___________ ________, and arrhythmia, or abnormal electrical ________ pattern of the heart  When the heart is fibrillating, it does not ______ blood effectively  Defibrillator is a machine that delivers and ________ _______ to the heart to try to restore the normal electrical pattern and rhythm.  ________ ________ __________(AEDs) are available for use by trained first responders, emergency medical technicians, and even citizens

22. Defibrillators (cont)  After _______ pads are positioned on the victims chest, AED determines the heart ______, recognizes abnormal rhythms that may respond to defibrillation, and sounds an audible or visual warning telling the operator to push a “______” button.  Some AEDs are fully automatic and even administer the shock  Anytime a shock is administered with an AED, it is essential that no one is ________ the victim  Rescuer should state “_____ _____ _______”  Look carefully to make sure no one is in _____ with the victim before pushing the _____ button  Serious injuries, such as _____ _______, can occur if shocked by the AED

23. Performing CPR  Evaluate victim’s condition before starting CPR:  Check if patient is conscious, as “___ ___ ___?”  If unconscious, check for _______  If not ______, place victim on back  Open the ______ by using the head-tilt/chin lift or jaw-thrust maneuver  Call out for help, or ask someone to call 911 (continues)

24. Performing CPR ( continued )  ___________ for chest movement  _________ for breathing  ___________ for movement of air from the nose or mouth  If not breathing, give ____ breaths  Make sure breaths are effective  Then check the carotid pulse  Where is the carotid pulse? (continues)

27. Correct hand placement  Adults:  Hand is placed on the lower half of the sternum between the nipples  Use the middle finger of hand to closest to victim’s feet to follow the ribs up to where ribs meet sternum at the substernal notch  Keep middle finger on notch and position index finger next to it  Place heel of opposite hand (closest to victim’s head) on sternum next to index finger  Prevents danger of incorrectly applying pressure on the xiphoid process

28. Administering Chest Compressions  After positioning your hands on the sternum, straighten your arms and align your shoulders directly over your hands  Push straight down on the victim’s sternum with a hard fast motion  On an adult, the sternum should be compressed 1 ½ to 2 inches  After each compression, allow the chest to recoil completely  Deliver compressions at a rate of 100 compressions per one minute  Proper administration of compressions will produce adequate blood flow and improve the victim’s chance of survival

29. Various methods of CPR used  Adult, child or infant  One-person adult rescue for adult  30 compressions followed by 2 ventilations (30:2 ratio)

30. (continues) Performing CPR ( continued )  Two-person adult rescue for adult  30 compressions by one rescuer followed with 2 ventilations by the second rescuer (30:2 ratio)  CPR for infants (birth to one year)  30 compressions followed by 2 ventilations for one rescuer (30:2 ratio)  15 compressions followed by 2 ventilations for two rescuers (15:2 ratio)

31. Performing CPR ( continued )  CPR for children (1 year to puberty)  30 compressions followed by 2 ventilations for one rescuer (30:2 ratio)  15 compressions followed by 2 ventilations for two rescuers (15:2 ratio)  CPR for choking victims  Reasons for stopping CPR

32. 16:3 Providing First Aid for Bleeding and Wounds  Wound is an injury to soft tissues  Open: break in skin or mucous membranes  Closed: no break in skin or mucous membranes, but injury occurs to underlying tissues  Wounds can result in bleeding, infection, and/or tetanus

33. Classifications of Open Wounds  Abrasion  Incision  Laceration  Puncture  Avulsion  Amputation

34. Controlling Bleeding  First priority because victim can bleed to death quickly  Bleeding can come from arteries, veins, or capillaries  Observe standard precautions (continues)

35. Controlling Bleeding ( continued )  Direct pressure  Elevation  Pressure bandages  Pressure on pressure points  Do not disturb clots  Do not remove dressings  Do not clean wound

36. Minor Wounds  First priority—prevention of infection  Wash your hands thoroughly before caring for wound  Put on gloves  Wash the wound with soap and water  Rinse the wound  Use sterile supplies

37. Signs of Infection  Swelling  Heat  Redness  Pain  Fever  Pus  Red streaks

38. Tetanus  Tetanus bacteria can easily enter an open wound  Serious illness  Get tetanus shot or booster as needed

39. Objects Embedded in Wound  Examples such as splinters, pieces of glass, or small stones  If superficial, gently remove  Objects embedded in tissues should be left and removed by physician

40. Closed Wounds  Can occur anywhere on body  If bruise, apply cold application to reduce swelling  Observe for signs of internal bleeding  Get medical help  Check breathing and treat for shock  Avoid unnecessary movement  No food or fluids

41. 16:4 Providing First Aid for Shock  Also called hypoperfusion  Shock: clinical set of signs and symptoms that are associated with an inadequate supply of blood to body organs, especially brain and heart  Causes of shock

42. Types of Shock  See Table 16-1 in text  Anaphylactic  Cardiogenic  Hemorrhagic  Metabolic  Neurogenic (continues)

43. Types of Shock ( continued )  Psychogenic  Respiratory  Septic

44. Signs and Symptoms of Shock  Skin is pale or bluish-gray and cool or cold to the touch  Diaphoresis  Rapid and weak pulse  Respirations rapid, shallow, and may be irregular  Blood pressure very low or unobtainable (continues)

45. Signs and Symptoms of Shock ( continued )  General weakness  Anxiety and extreme restlessness  Excessive thirst  Nausea and/or vomiting  Blurred vision or changes in appearance of eyes

46. Treatment for Shock  Goals of treatment  Positioning of victim  Maintain body temperature  Avoid food or drink  Other principles of care

47. 16:5 Providing First Aid for Poisoning  Can happen to anyone  Poison: any substance that causes a harmful reaction to the outside or inside of the body  Immediate action is needed  First aid varies depending on type of poison, injury involved, and the method of contact

48. Ways Poisoning Occurs  Ingesting various substances  Inhaling poisonous gases  Injecting substances  Contacting the skin with poison

49. First Aid for Poisoning  If poison has been swallowed  Methods to induce vomiting  If poisoning by inhalation of gases  If poisoning by contact with skin  Contact with poisonous plants  If poisoning by injection

50. 16:6 Providing First Aid for Burns  Injury caused by fire, heat, chemical agents, radiation, and/or electricity  Classifications of burns  Superficial  Partial-thickness  Full-thickness

51. Treatment Objectives  Remove source of heat  Cool the skin  Cover the burn  Relieve pain  Observe for and treat shock  Prevent infections

52. Treatment  Usually not required for superficial and mild partial-thickness burns  Rules for when to treat  All full-thickness burns require medical treatment  How to treat superficial and mild partial-thickness burns (continues)

53. Treatment ( continued )  How to treat severe partial- or full-thickness burns  How to treat when chemicals splashed on skin  How to treat eyes burned by chemicals or irritating gases

54. 16:7 Providing First Aid for Heat Exposure  Overexposure to heat may cause a chemical imbalance in the body  Occurs when water and salt are lost through perspiration  Also occurs when body cannot eliminate excess heat

55. Heat Cramps  Muscle pains and spasms  Caused by exposure to heat  Loss of water and salt  Apply firm pressure on cramped muscle to provide relief  Provide rest and move to cooler area  Small sips of water or electrolyte solution (e.g., sports drink)

56. Heat Exhaustion  Occurs when exposed to heat with loss of fluids through sweating  Signs and symptoms  First aid care

57. Heat Stroke  Prolonged exposure to higher than normal temperatures  Medical emergency—needs immediate care and attention  Body unable to eliminate excess heat  Signs and symptoms  First aid care

58. 16:8 Providing First Aid for Cold Exposure  Exposure to cold temperatures can cause body tissues to freeze and body processes to slow down  Needs immediate attention  Degree of injury affected by wind velocity, amount of humidity, and length of exposure to cold

59. Hypothermia  When body temperature is less than 95ºF (35ºC)  Caused by prolonged exposure to cold  Signs and symptoms  Death can occur if body processes become too slowed down  First aid care

60. Frostbite  Freezing of tissue fluids with damage to the skin and underlying tissues  Caused by exposure to freezing or below-freezing temperatures  Early signs and symptoms  Other signs and symptoms as frostbite progresses (continues)

61. Frostbite ( continued )  Objectives of first aid  Common sites: fingers, toes, ears, nose, cheeks  First aid care  Assess for signs and symptoms of shock and treat as needed

62. 16:9 Providing First Aid for Bone and Joint Injuries  Frequently occur during accidents or falls with variety of injuries  Examples: fractures, dislocations, sprains, and strains  May have more than one type of injury to bones and joints at the same time

63. Fracture  Break in the bone  Closed or simple fracture  Compound or open fracture  Signs and symptoms  Objectives of first aid

64. Dislocation  When the end of the bone is displaced from a joint or moved out of its normal position within a joint  Tearing or stretching of ligaments, muscles, and other soft tissues also frequently occurs  Signs and symptoms  First aid care

65. Sprain  Injury to tissues surrounding a joint  Common sites: ankles and wrists  Signs and symptoms  Sprains frequently resemble fractures or dislocations— treat as fracture if any doubt  First aid care

66. Strain  Overstretching of a muscle  Caused by overexertion or by lifting  Frequent site: back  Signs and symptoms  First aid treatment

67. Splints  Devices to immobilize injured parts  Types of splints  Pneumatic or air splints  Padded boards  Traction splints  Splints can also be made from cardboard, newspapers, pillows, boards, etc. (continues)

68. Splints ( continued )  Need to be long enough to immobilize the joint above and below the injured area to prevent movement  Should be padded  Tied in place  Apply as not to create pressure on affected area  If open wound, control bleeding before applying splint (continues)

69. Splints ( continued )  Never attempt to reposition bone  Splint before moving victim  Observe precautions when using pneumatic splints  Traction splints

70. Circulation Check After Splint  Verify that the splints are not too tight  Check skin temperature  Check color  Note swelling or edema  Numbness or tingling  Check pulse  If circulation impaired, immediately loosen the ties

71. Slings  Commercial slings  Triangular bandages  Use: support arm, hand, forearm, and shoulder  Positioning of sling  Check circulation  Limit movement of limb (continues)

72. Slings ( continued )  If using knots  Placement  Padding  Considerations for shoulder injury

73. Neck or Spine Injury  Most dangerous types of injuries involving bones and joints  Movement can result in permanent injury resulting in paralysis  Avoid any movement of victim if at all possible  Wait for backboard and adequate help to arrive for transfer

74. 16:10 Providing First Aid for Specific Injuries  Treatment for burns, bleeding, wounds, poisoning, and fractures is basically the same  Injuries to specific body parts require special care  Examples: eyes, ears, nose, brain, chest, abdomen, and genital organs

75. Eye Injuries  Always involves danger of vision loss  Best to avoid giving major treatment  Obtain help of a specialist  Foreign objects in the eye  Blows to the eye  Penetrating injuries that cut eye tissue

76. Ear Injuries  Can result in rupture or perforation of eardrum  Torn or detached tissue  Ruptured or perforated eardrum  Clear fluid or blood-tinged fluid draining from ear

77. Brain Injuries  Wounds and blows to head and skull can cause brain injury  Seek medical help quickly as possible  Signs and symptoms  First aid care

78. Nose Injuries  Nosebleeds are usually more frightening than serious  Nosebleeds also called epistaxis  Causes of nosebleeds  First aid care

79. Chest Injuries  Usually medical emergencies  Involve heart, lungs, and major vessels  Sucking chest wound  Penetrating injuries to the chest  Crushing injuries to the chest

80. Abdominal Injuries  Can cause damage to internal organs and bleeding in major blood vessels  Intestines and other abdominal organs may protrude from open wound  Medical emergency  Bleeding, shock, and damage to organs can be fatal  Signs and symptoms  First aid care

81. Injuries to Genital Organs  Result of falls, blows, or explosions  Can cause severe pain, bleeding, and shock  First aid care

82. 16:11 Providing First Aid for Sudden Illness  Can be difficult to determine exact illness being experienced  Base care on signs and symptoms  Information from victim if possible  Look for medical alert bracelets or necklaces or medical cards

83. Heart Attack  Known by other names as coronary thrombosis, coronary occlusion, or myocardial infarction  Occurs when there is blockage in one or more coronary arteries  If heart stops, start CPR  Signs and symptoms  First aid care

84. Cerebrovascular Accident  Also called stroke, apoplexy, or cerebral thrombosis  Causes  Signs and symptoms  First aid care

85. Fainting  Temporary reduction in supply of blood to brain  Early signs and treatment  If victim loses consciousness, try to prevent injury  Obtain medical help if recovery not prompt, there are other injuries, or fainting reoccurs

86. Convulsion  Type of seizure—strong involuntary contraction of muscles  Causes  Progression of a convulsion  First aid care is directed at preventing self-injury

87. Diabetes Mellitus  Metabolic disorder caused by lack of or insufficient production of insulin  Diabetic coma  Insulin shock  Differentiate between diabetic coma and insulin shock

88. 16:12 Applying Dressings and Bandages  Dressings used as sterile covering and to control bleeding  Materials used in dressings  Dressings can be held in place with tape or a bandage  Bandages used to hold dressings in place, to secure splints, and to support and protect body parts (continues)

89. Applying Dressings and Bandages ( continued )  Apply bandages snugly to control bleeding and prevent movement of dressing, but not to interfere with circulation  Types of bandages consist of:  Roller gauze  Triangular  Elastic

90. Methods to Wrap Bandages  Depends on the body part  Spiral  Figure-eight for joints  Recurrent or finger wrap

91. Checkpoints for Circulation  Check circulation after application  Signs of poor or impaired circulation:  Swelling or edema  Pale or cyanotic color  Coldness to touch  Numbness or tingling  Poor or slow capillary refill  Loosen bandage immediately

92. Summary  Proper first aid can save a life  Provide only care you are qualified to provide  Always reassure victim and avoid unnecessary stress and movement  Obtain medical help as needed